Iodine and Hashimoto’s Thyroiditis, Part 2

Mario Renato Iwakura’s guest series on the place of iodine and selenium supplementation in treatment of hypothyroidism continues. This is part 2. Thank you Mario! – Paul

In Part I (Iodine and Hashimoto’s Thyroiditis, Part I, May 24, 2011) we looked at evidence from animal studies that iodine is dangerous to the thyroid only when selenium is deficient or in excess, and that optimizing selenium status allows the thyroid to tolerate a wide range of iodine intakes. In fact, there were some hints (such as an improved CD4+/CD8+ T cell ratio) that high iodine, if coupled with optimal selenium, might actually diminish autoimmunity.

If that holds in humans too, we should expect that populations with healthy selenium intakes should see a low incidence of thyroid disease and no effect from iodine intake on the incidence of Hashimoto’s thyroiditis. Is that the case?

Korean Study

Dr. K [1] quotes a Korean study [3] of Hashimoto’s patients. Half restricted iodine intake to less than 100 mcg/day, the other half ate their normal seaweed and iodine. Of the 23 patients who restricted iodine, 18 (78%) became euthyroid in the sense of having TSH below 4.43 mIU/L, while only 10 (46%) of the 22 that did not restrict iodine became euthyroid. There was no measurement of symptoms at all, and no report of thyroid antibody titers after iodine restriction, so we don’t know if the iodine restriction relieved the underlying autoimmune disorder.

The selection of subjects for the two groups was odd. Group 1, the iodine restricted patients, had an extremely wide range of starting TSH, averaging 38 mIU/L but with a standard deviation of 82 mIU/L. Since all subjects began with TSH above 5 mIU/L, it’s clear that many of the Group 1 members had TSH near 5 and others had TSH well over 100 mIU/L. In comparison, Group 2, the controls, averaged a TSH of 11 mIU/L with a standard deviation of 11 mIU/L – less than 1/7 the standard deviation of Group 1. Few Group 2 members had a TSH above 30.

Table 2 presents the results. Mean TSH in Group 1 was reduced a little, but it did not even come close to normal. Since 78.3% of Group 1 had TSH below 4.43 mIU/L after 3 months, the other 21.7% had to have averaged a TSH above 102.2 mIU/L at the conclusion of the study. The standard deviation of Group 1 TSH at the end of 3 months of iodine restriciton was 71 mIU/L.

Meanwhile, Group 2 members still had a much lower standard deviation at the end of the study: 19 mIU/L.

A conclusion of this study was that “the initial serum TSH concentration was significantly lower in the recovered patients than in the non-recovered patients, which suggests that the possibility of recovvery is increasingly rare as the initial hypothyroidism becomes more severe.” Since Group 1 originally had a much larger fraction of members with very low TSH than Group 2 (plus a few with extremely high TSH to raise the average TSH), and the definition of recovery was a reduction of TSH to 4.43, perhaps it is not surprising that a higher fraction of Group 1 recovered.

Further calling into question the conclusion that lower iodine intake is beneficial is another observation. Looking at Table 1, we see that Group 2 (controls) had, at baseline, much higher iodine intake and higher urinary iodine excretion. Despite this, goiter size, TSH, antimicrosomal (MSAb) and antithyroglobulin (TGAb) antibodies were all lower!

A Japanese Study

A similar study with similar results was done in Japan [4].

In Asia, high iodine intake is due to high consumption of seaweed. Seaweed is high in naturally produced bromine compounds [5][6][7], arsenic [9][12][13], and mercury [9], and can accumulate radioactive iodine [8][9][10][11]. All these substances are known to interfere with thyroid function.

Bromide levels in urine in Asia are very high and are associated with seaweed consumption [6][7]. Values of 5 to 8.1 mg/l have been observed among Japanese, and 8 to 12 mg/l among Koreans.

It is quite possible that any benefits from “iodine restriction,” i.e. seaweed restriction, were due to reduced intake of bromine, arsenic, mercury, and radioactive iodine.

A China Study

Dr. Kharrazian [2] cites a study done in China [14] comparing three different areas: one with iodine deficiency (Panshan), another where iodine is more than adequate (Zhangwu) and a third where iodine is excessive (Huanghua). More than adequate and excessive iodine was associated with increased risk for subclinical and overt hypothyroidism.

But, another study [15], done in the same regions, showed that, coincidentally, Huanghua, the region with excessive iodine, and Zhangwu, the region with more than adequate iodine, had lower median serum selenium concentrations than Panshan, where iodine was deficient. Blood selenium concentrations were 83.2, 89.1 and 91.4 microg/L, respectively. So iodine consumption was inversely related to selenium consumption. Was it lower iodine, or higher selenium, that was beneficial?

Studies from Brazil, Sri Lanka, Turkey, and Greece

Dr K also cites a rise in Hashimoto’s incidence in Brazil, Sri Lanka, Turkey and Greece after salt iodinization began. Are these countries deficient in selenium? Well, lets see:

Brazil: The study was done in São Paulo, a city with a large Brazilian-Japanese population. Brazilian-Japanese have significant lower levels of Se than Japanese living in Japan [16].

Greece: Selenium status is one of the lowest of the Europe [17].

Turkey: Selenium status of Turkish children is found to be unusually low, only 65 ng/ml in boys and 71 ng/ml in girls [18]. Turkey is characterized by widespread iodine deficiency and marginal selenium deficiency [19].

Sri Lanka: Significant parts of the Sri Lankan female population may be selenium deficient [20].

One study, done in Egypt, measured iodine excretation in urine and its relation with thyroid peroxidase antibody (TPOAb) [21]. Although the abstract said that a significant correlation was found, this is far from reality, as we can see from Fig. 2.

Another study from Brazil [2] measured urinary iodine excretation and serum TPOAb and TgAb antibodies from 39 subjects with Hashimoto’s, none of whom were receiving treatment at the time of the study. Both antibody titers had no obvious correlation with urinary iodine.

Two discordant epidemiological studies

From the Netherlands, we have a prospective observational study looking at whether the female relatives of 790 autoimmune thyroid disease patients would progress to overt hypothyroidism or hyperthyroidism [22].

Although the relationship was not considered statistically significant, they found that women with high iodine intake (assessed through questionnaires) were 20% less likely to develop thyroid disorders.

Another study from western Australia (a region that has previously been shown to be iodine replete) measured urinary iodine concentration (UIC) of 98 women at 6 months postpartum and checked their thyroid status both postpartum and 12 years later [23]. UIC at 6 months postpartum predicted both postpartum thyroid dysfunction and hypothyroidism 12 years later:

In short, the more iodine being excreted (and thus, presumably, the more in the diet and in the body), the less likely were hypothyroid disorders – not only at the time, but also 12 years later.

Dangers of selenium supplementation in iodine deficiency.

Selenium supplementation when iodine and selenium deficiencies are both present can be dangerous, as the experience in northern Zaire, one of the most severely iodine and selenium deficient population in the world, shows [25].

Schoolchildren and cretins were supplemented for 2 months with a physiological dose of selenium (50 mcg Se per day as selenomethionine). Serum selenium was was very low at the beggining of the study and was similar in schoolchildren and in cretins (343 +- 190 nmil/L in schoolchildren, n=23, and 296 +- 116 nmol/L in cretins, n=9). After 2 months of selenium supplementation, the massive decrease in serum T4 in virtually every subject can be seen in fig. 4 below:

Another previous similar trial, this time done in 52 schoolchildren, reached the same results: a marked reduction in serum T4 [26][27]. This previous trial “was shown to modify the serum thyroid hormones parameters in clinically euthyroid subjects and to induce a dramatic fall of the already impaired thyroid function in clinically hypothyroid subjects” [27].

What stands out is the difference in the results between euthyroid schoolchildren and cretins/hypothyroids. Two months of selenium supplementation was probably not enough time to affect significantly the thyroid of the euthyroid schoolchildren (althougt already impacted T4 and fT4). But, in cretins and hypothyroids, where the thyroid was already more deficient, the impact was evident.

Conclusion and What I Do

Iodine and selenium are two extremely important minerals for human health, and are righly emphasized as such in the Perfect Health Diet book and blog. I believe they are fundamental to thyroid health and very important to Hashimoto’s patients.

A survey of the literature suggests that Hashimoto’s is largely unaffected by iodine intake. However, the literature may be distorted by three circumstances under which iodine increases may harm, and iodine restriction help, Hashimoto’s patients:

All three of these negatives can be avoided by supplementing selenium along with iodine, using potassium iodide rather than seaweed as the source of iodine, and increasing iodine intake gradually.

It’s plausible that if iodine were supplemented in this way, then Hashimoto’s patients would experience benefits with little risk of harm. Anecdotally, a number have reported benefits from supplemental iodine.

Other evidence emphasizes the need for balance between iodine and selenium. Just as iodine without selenium can cause hypothyroidism, so too can selenium without iodine. Both are needed for good health.

A few months after I was diagnosed with Hashimoto’s I started 50 mg/day iodine plus 200 mcg/day selenium. If I were starting today, I would follow Paul’s recommendation to start with selenium and a low dose of iodine, and increase the iodine dose slowly. I would not take any kelp, because of potential thyrotoxic contaminants.

Currently I’m doing the following to try to reverse my Hashimoto’s:

PHD diet and follow PHD book and blog advices to enhance immunity against infections, since infections seems to be implicated in Hashimoto’s pathology [28][29][30]. I give special attention to what Chris Masterjohn calls “traditional superfoods”: liver and other organs, bones and marrow, butter and cod liver oil, egg yolks and coconut, because these foods are high in minerals, like iodine, zinc, selenium, copper, chromium, manganese and vanadium, all of which seems to play a role in thyroid health [31];

High dose iodine (50mg of Lugol’s) plus 200 mcg selenium daily. These I supplement because of their vital importance to thyroid and immune function;

3 mg LDN (low dose naltrexone) every other day to further increase immunity. LDN resources are listed below [32][33][34][35][36];

Avoiding mercury and other endocrine disruptors. When I removed 9 amalgams (mercury), my TPO antibodies increased for 3 months and took another 6 months to return to previous values. I also avoid fish that have high and medium concentrations of mercury. Cod consumption increased my TPO antibodies;

1g of vitamin C daily. Since it seems to confer some protection against heavy metal thyroid disfunction [37], improve thyroid medication absorption [38] and there is some evidence that it could improve a defective cellular transport for iodine [39];

Donating blood 2 to 3 times per year. In men, high levels of iron seems to impact thyroid function [40].

Final Thanks

I would like to make a special thanks to Paul Jaminet for giving me the opportunity to write this essay, for gathering many, many papers for me, and for having the patience to revise both posts and suggest many changes that made the text clearer; and to Emily Deans who kindly sent me one key study that Paul could not get.

316 Comments.

Thanks. I encourage you to check it out. The test is inexpensive, can be done on your own at home, and reportedly accurate to reflect stores of iodine in the body. I think it may be useful to many people who have thyroid issues but are unsure whether iodine sufficiency is part of their problem or perhaps something they can rule out. Guessing about what to take and how much to take based solely on concurrent physical reactions is very subjective and can be influenced my so many different variables aside from the one or two supplements one is keeping an eye on. Hope this makes sense! Thanks again.

Thanks Jay. Got it. I find it interesting that zrtlabs promotes the use of thyroid hormone status as a marker for Iodine sufficiency. On the one hand it’s kind of cool… but on the other hand it’s ignoring the sufficiency of the rest of the body. I guess since they are focused on thyroid that the reference ranges for their urinary Iodine test may be low or in-applicable for someone seeking optimal.

Since this was Posted in May of 2011 — I am wondering how Paul’s Thyroid is now (2013) and if he would change anything he took/ate/supplements if making suggestions for himself or others today. My Thyroid health has been going downhill since 2006 and since having Breast Cancer, has continued to worsen. I would be grateful for any input or suggestions. Thanks in advance.

The main difference is that after learning toward higher doses of selenium and iodine for a few years, I’ve shifted back to taking less than 1 mg/day iodine and selenium only once a week. Also I supplement low-dose lithium now which affects the thyroid.

Paul, how do I fix the mistake of taking too much iodine? I started in Jan’13 with iodine of 1mg/day and zero selenium supplementation. At he same time, I began Bulletproof’s Rapid fat loss protocol. The end result is not too wonderful as my February blood test results show: my total cholesterol doubled to 440 and my TSH hormones doubled to 2.84. Seems like the case of reactive hypothyroidism.
So how should I adjust my iodine and selenium intake considering my history? (By the way, I eat liver weekly and grass-fed beef almost every day.) Your advice is much appreciated!

I would immediately reduce the iodine to less than 1 mg/day, 225 mcg/day is enough, and take selenium supplements 200 mcg/wk. I’d also add some carbs in. I’m not quite sure that the iodine/selenium is behind your problem, it’s probably more likely you have been too low carb.

That was a fast reply. Thank you, Paul! In order to better understand this issue, what’s the main reason for your selenium dosage recommendation? Dave Asprey recommends 200mcg per DAY not per week (he also suggests taking 1mg / day of iodine). Thanks.

Our diet is very selenium rich (beef, lamb, seafood, eggs) so I’m concerned about selenium overdose. I developed a selenium overdose a year ago on 200 mcg/day and you’ll see in the new edition discussion that selenium content of food is highly variable.

1 mg/day iodine should be OK but since you’ve had a problematic experience might as well be cautious. 225 mcg is enough for optimal thyroid function.

I do think that insufficient carbs is more likely than an iodine or selenium overdose.

Paul, to clarify, is 225 mcg of iodine optimal for anyone or for people with a sluggish thyroid? I’ve been on this dose since early march and wondering if I should double it. I haven’t re-tested my sluggish thyroid but probably should since I gained 10 lbs since march after starting also eating carbs per your recommendation. Frustrated with the weight gain especially because i am doing IF four days a week. Need to tweak something here. Thank you!

Here is an example of the natural treatment of Hashimoto’s that I had to share. This is a real case based derived from the research if Dr. Guy Abraham and Dr. Brownstein:

Previous diagnosis of ADHD and Ritalin prescribed.

Female patient diagnosed with Hashimoto’s in September 2010 at the age of 13. Initial antibody levels were TPO(Ab)= 253, and Tab=838.

About September 2010 started Synthroid at 100 mcg/day and remained stable.

About October 2010 first Homeopathic intercurrent remedy given at 200C.

About November 2010 started on Abilify for Bipolar disorder.

January/February 2011 started to complain about sore feet. Nothing could be found causing this but it continued.

About March 2011 second Homeopathic intercurrent remedy given at 200C

April 2011 started on Selenium averaged to 200-300 micrograms per day as a mix of L-Selenocysteine, L-Selenomethionine, Se-methylselenocystine., Vit. E, C, B Complex, Cal/Mag citrate with extra magnesium. Also occasional use of zinc and iron. Almost immediately feet became much more sore very quickly to the point she could not walk very far at once. Although sore feet are not listed as a possible side effect of Abilify, cases can be found on the message boards of it causing this. Abilify was quickly stopped over a seven day period and the sore feet problem was gone. We must stop and wonder of Abilify was masking a problem with Selenium deficiency in the brain or this was a coincidence. What is interesting to consider is the role of Selenium in the brain. The largest concentration of Selenium is found in the brain and the Thyroid being second. The enzymes made from Selenium seem to protect the brain from oxidative damage. (You may research Selenium, depression, seizures, and the brain separately.)

Selenium was not taken every day. Rather the dose was increased on days taken so it averaged out to the equivalent of 200-300 micrograms per day. Selenium has a long half life in the body which helps this average out nicely. (Note: This is important. However, although other vitamins were not taken daily either, their dose was NOT increased on days taken to average out to a recommended daily amount.) The timing of using the protocol was not by choice, but by logistic limitations.

May 2011 started on kelp for small amounts of Iodine. One kelp capsule per day increasing to 4 per day over a period of a couple of weeks.

About June 2011 was started on Lamictal for bipolar disorder.

Over the next two months Kelp was switched to either Lugol’s Solution or Iodoral and dose slowly increased from 6mg per day to 50 mg/day. (Note: A pulsing method was used where this overall protocol was not taken every day. It would typically be taken 3 days per week up to about 10 days in a row. This was done for logistical reasons rather than desire. This included the vitamins done as a pulsing protocol. )

Salt and water detox protocol was stared part time based on Celtic Sea Salt.

May 2012 a constitutional homeopathic remedy was given at 200C. Friends and family noticed an improvement in her temperament. This appeared to be a proper selection. She also stopped experimenting with smoking Tobacco which is interesting because the remedy selected is a classic one for addictive personalities and addictions.

June 2012, thyroid antibodies were measured. TPO(Ab)=148, Tab=442. This was a sizable reduction for the original diagnosis. Additionally, TSH was low and T4 was high. (Note: It was necessary to discontinue Iodine about three weeks before these test in order to allow the TSH to normalize and not confuse the endocrinologist. If not done, then TSH and T4 will both be high and the endocrinologist will be freaked out. )

June 2012, Synthroid was reduced to 88 mcg per day.

Between May 2012 and November 2012 the constitutional homeopathic remedy was repeated every two weeks to two months at a 200C potency.

December 2012 Thorne Meriva-500 and M.F. Bromelain were added to the protocol. Two caps of each on days when the protocol was in use, usually 3 but up to 7 days per week.

December 2012 a different Homeopathic constitutional remedy was given at 200C. This is a complementary remedy to the first.

January 2013 the second homeopathic constitutional remedy was given at 1M.

I have hashimotos as well as type 1 diabetes. I read Dr. Browstein’s book on iodine and instantly started to take 50 mg of iodine with 100 mcg of selenium. This was in addition to the 1 grain Nature-Throid med I am taking. The first few days I began to see a difference in my blood sugars. They seemed to be a lot lower and I didn’t have to take as much insulin. Then my blood sugars began to increase, often not even responding to insulin correction. I do not have symptoms of hyperthyroidism ie heart palpitations and my BBT is at 97.8F. I don’t know what to do because most doctors that I talk to are unfamiliar with iodine including the nature path I am seeing now who insists the iodine will aggravate my thyroid condition. Do you have any advice?

I started adding more starch into my diet about 6 months ago after stumbling on your website. Prior I had been very low carb and struggled with low energy levels. Shortly after adding more starch I was going to the gym 4 times a week and lifting weights. I also ordered your recommended supplements. It was the first time I supplemented Iodine and I made a big mistake with the selenium. Instead of 200mcg a week I was taking 200mcg a day for over two months with 225 mcg of Iodine. I already ate plenty of eggs and fish. I began to start feeling very sick and feverish and ad extreme thirst and fatigue, so much so that I had to stop going to the gym. It feels like some sort of infection. I believe this was began because of my high intake of selenium. I have previously had a TSH of 4.45 in 2011. (At the time I was unaware that this was high and the doctors never told me.)

I have since corrected my selenium dosage to 225mcg a week and have increased my iodine up to 1.5 mg a day. The higher dose of iodine seems to keep the sick feeling at bay but it comes back when I stop using it.

I recently had my thyroid checked to see if any damage was done and these are my results:

For me, one of the most valuable parts of this article was seeing how selenium supplementation with an iodine deficiency could could lower T4 and create potential thyroid issues. I’ve never see that information before. I also wonder, having supplemented between 200-400mcg of selenium daily for years, while avoiding iodine in supplements and not eating seafood, might play at least a minor role in my mysterious hypothyroid issues which my naturopath and MD can’t seem to get a handle on (I am not taking meds at this time). Will try adding a moderate amount of iodine.

I have Hashimoto’s and PCOS. I am trying to get a grip on my supplements as I am having difficulty treating the Hashimoto’s naturally. I was on 25 mg. of Synthroid for a year when first diagnosed but I quickly went hyperthyroid on it because I believe I was eating foods high in iodine and this on top of the synthroid, was pushing me over to hyper. I stopped the synthroid because I didn’t feel it was helping. I began to eat foods high in iodine and this did help me for a while, but it became too difficult to keep that diet up. Now, I am taking some supplements that I believe are helping but I just can’t seem to get it down pat.

Currently I am taking:

1 gram of Vitamin C (I have adrenal fatigue and this seems to be helping. If I am particularly stressed, I will take an additional gram later in the day, for a total of 2 grams a day).

I take a children’s chewable multivitamin because I have not found an adult multi that I like that does not have herbs in it. The brand is called Dinosaurs and I take 3 vitamins, as one is the recommended dose for 2-4 yr. olds. I am in my late 30’s.

10,000 iu of Vitamin D3 a day. Doctor found extremely low levels of Vitamin D. The levels went up this summer due to supplements and sun exposure during summer, but now that it is fall/winter, I feel I need this amount.

100 mg. of Selenium a day. I was taking 200 mg. a day but multi has selenium and I could also eat food that has selenium, I found it better to take the 100 mg. to avoid getting too much. Not sure if this is ok or if I should go up.

Because of the PCOS, I take extra inositol (500 mg. a day). I try not to eat sugar or carbs but I have trouble cutting both out of my diet completely so this is supposed to help with regulating blood sugar.

Here is where I have the problems:

I go back and forth between thyroid supplements. I took the Gaia Thyroid Support for a while and that seemed to be working out ok, but I am not all that comfortable with the amount of herbs in the product. I have also tried Dr. Michael Murray’s Thyroid Health Formula, and this is ok too, but sometimes I feel it pushes me to hyper. I also took a Kelp supplement and that was ok too. I don’t know which of these three would work best. I don’t think either the Gaia or the Kelp supplements were enough as I still had very low energy while taking them.

I used to take L-tyrosine supplement, which I have heard is good to take for thyroid, but that is in the Dr. Murray and Gaia supplement so I don’t take it alone if I am taking the Gaia or Dr. Murray supplements.

I also recently decided to add a low dose (50) B-complex vitamin because of the lack of energy but I don’t know if this is going to be too much. I know B vitamins are good for thyroid but I don’t know if this would be too much on top of the multi and foods I eat.

Additionally, I take a progesterone supplement due to the PCOS.

So, that is it. Do you have any recommendations for me or suggestions? Thank you!

In general you should experiment with Synthroid doses. Doctors can’t know what dose is right for you, and so you should cut pills into fractions and try various amounts until you see which makes you feel best.

I think it’s good to take a low but regular dose of iodine, say 225 mcg per day in supplements plus some seaweed and seafood in your diet.

You can take extra vitamin C, I recommend getting a powder and using it to flavor water.

Selenium — if you eat the PHD recommended foods of beef/lamb and seafood you probably don’t need to supplement selenium at all. If you day, try 200 mg once or twice a week.

You might take choline with the inositol.

I am also skeptical of supplementing herbs. I would recommend the standard PHD supplements and supplemental foods, and diet, and circadian rhythm strategies.

Thank you for the choline with inositol suggestion. I feel so much better and feel that there was something wrong with my liver (I have liver pain and have had gallstones in the past) and after taking the choline w/ inositol I feel this problem is now healing. Would this light liver cleanse help with thyroid issues? I am currently not taking my synthroid and have found that the kelp and iodine made my throat hurt so I stopped them completely. I think there is a connection with my liver functioning better and my thyroid seemingly functioning better now. I think the Choline was the answer ❗

Paul – After a brief rash of hypo/hyperthyroid symptoms, I traced brain fog/head pain/hot flashes,/cold hands and feet/swelling feeling in neck to eating 2 packages of wakame in quick succession a week or two ago. Also potentially 1-2 capsules of kelp around the same time. (Unsure if this is accurate, but my symptoms seem to largely fit hypo/hyperthyroid – also had some night sweats, constant head pain, some weight fluctuation, and lots of joint pain.) Only other thing I can t hink of is too much Vit D supplementation 1-2 mnths ago, when I started with 5000 IU D/ 500 mg K2. I’m hoping to correct that by supplementing K2 and have stopped supplementing D3 until I can get levels tested again.

If I haven’t been consuming or supplementing Iodine apart from the 2 packages of wakame and 2 kelp capsules but following the PHD, should I supplement with, say, 2-3 Brazil Nuts / wk _and_ ~225 mcg Iodine, or just the Brazil Nuts to correct potential Se deficiency from the sudden consumption of lots of Iodine?

Iodine is used in tissue and for thyroid hormone. It takes about 3-4 weeks for the body to reach equilibrium when iodine intake changes.

Thyroid injuries often generate damaged cells/nodules which produce thyroid hormone unrestrictedly from iodine. If you have that, you will be hyperthyroid after eating a large dose of iodine, say from seaweed.

I would make sure you vitamin A levels are good by eating 1/4 lb liver per week and lots of carotenoid rich plants (spinach, sweet potatoes, carrots), and avoid any large doses of iodine such as kelp (you shouldn’t eat kelp). Small amounts of wakame may be tolerable. Avoid iodine for a bit but then try adding small amounts. You can get our 225 mcg tablets which are pretty small and cut them with a razor into quarters. Try 56 mcg/day at first and if that is well tolerated for a month, then double it to half a 225 mcg tablet per day.

Low doses of daily supplemental iodine are protective against thyroid injury, so they’ll make future hyperthyroidism less likely, but iodine can exacerbate pre-existing hyperthyroidism.

Just finished reading the article and all comments. Very interesting and well-researched. I was diagnosed with Hashimoto’s/chronic thyroiditis after a fine needle biopsy of a thyroid nodule, but all blood work is extremely “normal.” Primary care & endo dr. are not interested in treating symptoms (brain fog, fatigue, lack of interest, etc.). Would I be a candiate for iodine supplementation? Many thanks for any thoughts or suggestions.

I posted here, as it is a thyroid issue, I hope that is ok. My doctors have had trouble regulating my thyroid since the birth of my daughter 4 years ago. You probably won’t remember as you have so many people asking questions, I had Graves’ disease, radiation and I now have CVID and take plasmapheresis. My TSH is suppressed but my total T3 is 40 (90-190). For some reason I’m having some kind of thyroid crash. I’ve gained 14 lbs in one month! I want to do damage control. Here is where I am confused:

I was thinking of going on a ketogenic diet and lower carbs, but would that further reduce the conversion of my T4 to T3? I was thinking of increasing my coconut oil consumption as well. I’m also taking iodine drops.

Anyone have experience with this? I was 138 December 1, I’m now 151. My weight has been the same for 20 years outside of pregnancy. I feel like I’m going to explode if I keep going at this rate.

This is by far one of the best collections of science regarding thyroid I have found since my eruption of hypothyroid symptoms in the last couple of weeks.

I am a female in my late 20’s, and have been explaining away numerous hypo symptoms my whole adult life. Recently, I decided I didn’t feel very healthy (decreased energy, mental fog, perception of environment, etc.) so I decided to do a 5 day juice fast. I felt more sluggish and apathetic than ever, but completed the cleanse. At the same time, I decided a kelp supplement was a good idea and took one capsule per day for a little more than a week. I have since stopped after discovering the dangers of kelp and heavy metal retension. Since the cleanse several more acute symptoms have popped up – dark circles under eyes, puffy face, extreme dry eye and mouth that disrupt daytime and sleep, tinnitus that keeps me awake at night, increased lethargy. I am waiting on a doctors’ appointment with my naturopath, but feel I am going downhill quickly. Swallowing seems to be somewhat impaired in the last day or so, which could be related to the dry mouth, or could be swelling in neck – I can’t tell. I have lost 10 pounds in the last week (not the goal), but have also given up sugar, coffee, and for a long time now have been gluten free and processed food free. Three weeks ago I rid my water of fluoride and chlorine with a Big Berkey water filter, and have been drinking a TON more water (doesn’t taste like poison anymore, yay !).

I strongly suspect iodine deficiency (transdermal disappeared in less than 8 hours), and hashimoto’s, maybe sjogren’s. I have so many questions, but I will keep it simple. I want to start supplementing selenium as naturally as possible, and also T/D iodine. I am frightened that doing so may put me in a tailspin. I suspect that removing the iodine insults from my diet, temporarily adding kelp, and rapid weight loss (10 lbs in 1 week) due to juice only diet may have already begun the tailspin.

Any advice would be greatly appreciated, as I want to be prepared when I meet with my doctor and this is all happening so quickly. It’s frightening.

Thank you, Paul, and anyone else who has been through something similar and cares to share.

Usually selenium supplementation is not necessary on PHD since it is a selenium rich diet (beef, lamb, seafood, eggs are all selenium rich), but it wouldn’t be bad to supplement for a week or two just to make sure. You don’t want an excess either though, so don’t supplement routinely, or limit it to once per week (200 mcg).

Iodine — I recommend a steady low supplemental dose, like 225 mcg/day or 150 mcg/day, plus eating plenty of seafood and seaweed. The seafood provides most of the iodine but the supplements ensure that you get a steady amount every day which is beneficial for thyroid health — no big fluctuations in thyroid dose. If you take a large dose of iodine in a deficient state, that can harm the thyroid (maybe something like that happened to you).

But the key to curing hypothyroidism is general good health practices and healing the gut. So you want to eat PHD and follow our lifestyle advice, especially circadian rhythm entrainment (chapter 42).

Further, the continuous, unsustainable groundwater withdrawn from the Guanajuato region has led to the groundwater table dropping at an astounding 1 m/year. This over-exploitation of the groundwater has led to continuously higher levels of arsenic and fluoride to unhealthy drinking water levels.

So we have this regime of Iodine and Selenium. But it looks like nobody really has cured their disorder using this?

I think this occurs due to accumulation of heavy metals in the gland causing the attack rather then a pathogen.

Where do you get 1mg tablets of iodine, Iodoral is 12.5mg.

So at moment TSH is around 3.33 Abs are in the 400s and I get hair falling more and joint problems and tingling in hands and muscle twitches. Can taking Iodine really help this, as it seems there is iodine deficiency.

Do people find using NDT is more reliable then iodine? Does NDT help the gland rest and help it recover?

I agree, sushi rolls are toxic due to the heavy metals in them and I think this is causing the problems not the iodine in it, and once your gland has these metals your pretty screwed.

I just started taking the Iodine Plus 2 supplement. 1 tablet daily with a dosage of 12.5 mg iodine/iodide 15 mcg Selenium and 15 mg Vitamin B2. Along with this, I am taking 1000 iu of D3. I do not wish to exasperate my condition or cause harm to my already low functioning thyroid. Please advise, as I have been told iodine added to your system could cause thyroid cancer. I wish to be proactive after 15 years of suffering without much positive results. I am also taking a prescription from my doctor of 0.15mg of levothyroxine (synthroid). I would appreciate your input especially regarding the intake of iodine. Thank you.

Hi Paul. I dont take supplements but after reading your take on hashimoto’s and iodine I decided to start eating more sushi, nori sheets and seafood in general. I am eating PHD for about 4 months now (but i would never touch those iodine rich foods because of what I read from other thyroid doctors). I eat plenty of salmon, sardines and eggs however. My antibodies used to be more than 1000 now they are around 450. I think after 4 months on the diet its time to experiment with the iodine issue. do you think for women who struggle with weight loss and hashi’s, taking iodine/eating iodine rich foods will most likely cause weight gain or weight loss? and have you had any sucess stories from women?

From one “Hashi” to another, Plz consider selenium along with iodine. Just taking iodine but not selenium can make a Hashi sicker. Also, having one autoimmune condition increases your likelihood of developing another, so it’s important to clean up your life/food/thoughts. GreenMedInfo can connect you to awesome health summits, including thyroid and autoimmune issues and experts in health, unlike conventional western medicine/food plan which likely contributed to your developing Hashi in the first place.

Thank you so much for your help. Very kind of you to answer. I have had swings between hypo and hyper which led me to be constant hypoglycemic. Although I didn’t had a diagnosis for that (only for Hashi’s 6 years ago). After eating PHD for a couple of months I am no longer hypoglycemic.. but I am still afraid of Hashitoxicosis and/or developing another auto immune disease. I have raynaud’s in the winter also so my immune system is wrecked. My antibodies are much lower eating PHD but as far as I know I can only be “at peace” if they’re down to less than 20. I don’t know what is the probability of developing more autoimmune diseases though, but that scares me. I am only 21 years old.

Great, great, GREAT article Paul! I am a specialist at a clinic in Tampa, FL that specializes in Thyroid disorders such as Hashimoto’s disease and you would not believe how many doctors are misguided on this subject. Please continue to post and keep the public informed about important issues such as this.

If any of you are interested, we offer complimentary consultations (completely free of charge) and can work with those in other states or areas and help them get back on their feet! Feel free to call us at 813-341-2600 or visit our webpage at http://www.amowc.com/thyroid . Hope this reaches the right hands and helps some of you! 🙂

I am a young adult male currently being treated for hypothyroidism with possible Hashimoto’s. Lat October my TPO antibodies were <10 and TgAb was <20. Dr. still thinks I may have Hashi's though because my mother does.

I have my follow up bloodwork coming up very soon. Currently I haven't been supplmenting any iodine but have been consistently taking 200mcg of Selenium per day. I eat a whole foods paleo type diet so I'm now concerned I might have too much Selenium.

Couple of questions:
* Should I reduce my Selenium? If so, to 100mcg?
* It looks like I should add iodine. I have a bottle of Lugol's. Would one drop be too much?
* My upcoming bloodwork includes TPO/TgAb tests and T3, T4, etc. Should I introduce some iodine beforehand while keeping my selenium the same (200mcg), eliminate selenium and not add iodine, or not add iodine and keep or reduce my selenium? Getting the right labs has been hard to come by so I want to make the best use of them.

Hi Paul,
I was hoping you would elaborate on your personal decision to stop taking mg doses of Iodine. I am in the process of seriously considering Dr. Brownsteins protocol for Hashimotos. You mentioned above that you experienced selenium toxicity, but why did you choose to stop the mg doses of iodine. Many of the people i have spoken too claim that the iodine protocol was the only thing that worked for them, and eliminated their antibodies. As you know there is always contradictory information when it comes to treating Thyroid disorders, but i am interested to know more about your experience.
Thank you.

We’ve had plenty of Hashimoto’s cures on PHD without high doses of iodine. I stopped the high doses of iodine when I developed a thyroid injury, concurrent with overdosing on selenium. Once I realized how easy it is to overdose on selenium I became convinced the risk exceeds the potential reward from high dose iodine. A few readers have developed problems on high dose iodine as well.

Hi Paul,
I just finished Brownstein book and his iodine doses recommended are way higher then yours. I wonder and seriously I cannot understand why if iodine can help so much according to Brownstein why most of the functional medicine world is against it when it comes to hashimotos? Would not this be as simple as test your iodine , if deficient supplement and don’t worry about tsh and wait for the miracle cure after some time? Is browstein crazy or maybe he knows more about iodine the others? I have headed in one of his interviews that he healed his children from hashimotos with the use of the iodine. I don’t thing that he would be that stupid to harm his own kids. I just don’t get it what is going on with the iodine?

I am wondering about your comment on Tregs. I think I read man y years back that Prilosec had this curious side effect of increasing Tregs when taken on an empty stomach-so as to not unduly lower stomach acid. So could Prilosec have a positive effect on the Tregs involving the thyroid?

Hi, Dr. Jaminet:
I have had elevated cholesterol from I was a child (230-300 TC) probably inherited from mother (she hadn`t so high). I was one year with statins but after a positive result of coronary TAC I sttopped taking them
1.5 years ago I started a low carb diet and cholesterol increased till now (433 TC). TSH increased too form 2.06 to 5.83. Now T4 is normal but T3 is in the minimun of the range, and low TPO .
I have started increasing my carbs.
I don`t know if the TC have been increased because of my probably familiar hypercholesterolemia (only mother) or hypotiroidism and I will try suplemnt with iodine and sellenium for avoid taking statins again.
What dosis of iodine and sellenium do you advise me to start and to continue? How much time or till wich level of TSH?

Hi Triki, TC of 220-240 mg/dl is normal. So getting back to the low end of your historical range would be perfect. The high cholesterol does indicate you were too low carb. The hypothyroidism is also elevating LDL. You should be getting the hypothyroidism treated with levothyroxine, also supplement iodine 225 mcg/day. Check your iron levels, aim for ferritin of 50-130, if it is higher than 130, donate blood. Selenium you may not need but 200 mcg/week is fine. Take a levothyroxine dose that gets TSH to 2.0 or so.

Thank you very much, Paul. My ferritin levels were a bit high 15 years ago (120-200) but last 4 years, before taking statins and low carb diet they rounded 300 and with statins and low carb became 419. Last, with low carb but no statins 276 but I can’t donate blood.
My doctor is against suplementary hormones so he will say me not to levothyroxine, but if it could be enough with iodine he would agree.

Hi Paul, I started supplementing with iThroid iodine 12.5mg for 12 weeks with a normal TSH of 2.4 and was asymptomatic at the time. After 12 weeks on iThroid, my TSH shot up to 14 and my FrT4 was low(.49). I was tested positive for TPOab(201) and negative for Thyroglobulin Abs. I was asymptomatic at the time, but got scared and discontinued iodine. Five weeks later, I started having issues with brain fog, headaches and fatigue which have increased in intensity. I was tested seven weeks after discontinuing iodine and all my thyroid levels (TSH, FrT3, Reverse T3 and THab) were normal with the exception of TPOab which was 161. I started a gluten free diet five days ago without any symptom improvement. Is it possible to have Hashimoto’s without the presence of Thyroglosbulin antibodies? I think I may have triggered this Hashimoto’s by taking iodine with a selenium deficiency. I am getting a blood serum test for selenium and I am planning on getting an iodine test through ZRT Laboratories before I start any iodine/selenium supplementation to address the TPOab as well as my symptoms. I was planning to supplement with 200 mcg/day of Salenium and a low dose of iodine (225 mcg/day) and build up slowly with the iodine. Where do I get a 225 mcg dose? I hear Kelp tablets are bad and can contain toxins such as mercury and bromide.

Not sure if you are aware, but this is an old 2011 post.
Paul’s recommendations for Iodine and Selenium have changed (considerably).
These updates are in the latest book (i think).
& also on the Recommendations page here; http://perfecthealthdiet.com/recommended-supplements/

You can also read a number of comments on the topic by Paul in the comments above (search for Paul Jaminet to find all his comments).

& here are some quotes from the Recommendations page;
“Selenium 0 or 200 mcg per week depending on selenium content of food (if food is produced in dry, flat areas = high selenium, no supplements; rainy, well-drained areas = 200 mcg/wk)”

Iodine:
“Recommended dose 225 mcg/day (one tablet).”

OR: “Nori sheets have about 50 mcg each; 2-4 per day replaces supplements.”

I have been doing research on iodine and selenium and there is mixed evidence on its effectiveness. I have not found any case studies where people were completely healed of their autoimmune condition with iodine/ selenium or with any supplement for that matter.

In my opinion, diet (going grain free) is the best way to heal and seal the gut and heal the immune system. I would urge everyone to look into the GAPs diet. It has done wonders for my son’s allergies and asthma.

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